What Antidepressants are there?

The past decade has seen the introduction of many new antidepressants that work as well as the older antidepressants but have fewer side effects. Some of these medications primarily affect one neurotransmitter, serotonin, and are called selective serotonin reuptake inhibitors (SSRIs) . SSRI's are the most commonly prescribed antidepressant at the moment and include drugs like Prozac (fluoxetine), Zoloft (sertraline), Luvox (fluvoxamine), Paxil (paroxetine), and Celexa (citalopram).

The late 1990s ushered in new medications that, like the tricyclics, affect both norepinephrine and serotonin but have fewer side effects. These new medications include Effexor (venlafaxine) and Serzone (nefazadone). Other newer medications chemically unrelated to the other antidepressants are the Remeron (sedating mirtazepine) and the more activating Wellbutrin (bupropion). Wellbutrin has not been associated with weight gain or sexual dysfunction but is not used for people with, or at risk for, a seizure disorder.

Each antidepressant differs in its side effects and in its effectiveness in treating an individual person, but the majority of people with depression can be treated effectively by one of these antidepressants.

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Antidepressants may cause mild, and often temporary, side effects (sometimes referred to as adverse effects) in some people. Typically, these are not serious. However, any reactions or side effects that are unusual, annoying, or that interfere with functioning should be reported to the doctor immediately. The most common side effects of tricyclic antidepressants, and ways to deal with them, are as follows:

• Dry mouth --it is helpful to drink sips of water; chew sugarless gum; brush teeth daily.
• Constipation --bran cereals, prunes, fruit, and vegetables should be in the diet.
• Bladder problems --emptying the bladder completely may be difficult, and the urine stream may not be as strong as usual. Older men with enlarged prostate conditions may be at particular risk for this problem. The doctor should be notified if there is any pain.
• Sexual problems --sexual functioning may be impaired; if this is worrisome, it should be discussed with the doctor.
• Blurred vision --this is usually temporary and will not necessitate new glasses. Glaucoma patients should report any change in vision to the doctor.
• Dizziness --rising from the bed or chair slowly is helpful.
• Drowsiness as a daytime problem --this usually passes soon. A person who feels drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and to minimize daytime drowsiness.
• Increased heart rate --pulse rate is often elevated. Older patients should have an electrocardiogram (EKG) before beginning tricyclic treatment.

The newer antidepressants, including SSRIs, have different types of side effects, as follows:

• Sexual problems --fairly common, but reversible, in both men and women. The doctor should be consulted if the problem is persistent or worrisome.
• Headache --this will usually go away after a short time.
• Nausea --may occur after a dose, but it will disappear quickly.
• Nervousness and insomnia (trouble falling asleep or waking often during the night) --these may occur during the first few weeks; dosage reductions or time will usually resolve them.
• Agitation (feeling jittery) --if this happens for the first time after the drug is taken and is more than temporary, the doctor should be notified.
• Any of these side effects may be amplified when an SSRI is combined with other medications that affect serotonin. In the most extreme cases, such a combination of medications (e.g., an SSRI and an MAOI) may result in a potentially serious or even fatal "serotonin syndrome," characterized by fever, confusion, muscle rigidity, and cardiac, liver, or kidney problems.